Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2

with a mortality rate close to 100% if not treated within 12 to 24 hours (7). C. septicum is a normal commensal of the human intestinal tract and is ubiquitous in the environment. It is notorious for causing gas gangrene in the absence of trauma (8), which makes the diagnosis challenging without a high index of suspicion. It can produce several toxins including deoxyribonuclease, lecithinase, hyaluronidase, and hemolysins, which can lead to tissue necrosis, disseminated intravascular coagulation, intravascular thrombosis, and hemolysis. Factors causing defective host immunity, such as steroids, diabetes, neutropenia, and alcohol abuse, might lead to translocation of the bacteria. This organism has been reported to cause several infections, including clostridial myonecrosis (8), osteomyelitis, septic arthritis, panophthalmitis, aortitis, intraabdominal abscess, intracranial infections, and abdominal wall cellulitis. Localized pain, inﬂammation, crepitation, gas production, disproportionate tachycardia, discolored edematous skin, and features of systemic toxicity are features that raise clinical suspicion (9). Gas may be seen in tissues on x-rays and computed tomography scans in cases of gas gangrene and is due to the production of nitrogen and hydrogen by the organism. Even with eﬀective treatment, including debridement and antibiotics, the mortality rate approaches 60% (10). The drug of choice for this infection is penicillin G. The extended-spectrum cephalosporins, carbapenems, and metronidazole are the usual alternatives in patients allergic to penicillins. Clindamycin, being a protein synthesis inhibitor, is believed to help reduce toxin production by the organism. Amputation might be needed when limb salvage is not possible. No controlled studies are available 112 regarding the use of hyperbaric oxygen therapy. Another concern regarding hyperbaric oxygen therapy is that compared with other clostridia, this organism has more tolerance to oxygen (11). Factors associated with poor prognosis are presentation with septic shock, immunosuppression, liver disease, and delay in initiation of treatment. Mirza NN, McCloud JM, Cheetham MJ. Clostridium septicum sepsis and colorectal cancer—a reminder. World J Surg Oncol 2009;7:73. 2. Katlic MR, Derkac WM, Coleman WS. Clostridium septicum infection and malignancy. Ann Surg 1981;193(3):361–364. 3. Sebald M, Hauser D. Pasteur, oxygen and the anaerobes revisited. Anaerobe 1995;1(1):11–16. 4. Maclennan JD. The histotoxic clostridial infections of man. Bacteriol Rev 1962;26:177–276. 5. Alpern RJ, Dowell VR Jr. Clostridium septicum infections and malignancy. JAMA 1969;209(3):385–388. 6. Wentling GK, Metzger PP, Dozois EJ, Chua HK, Krishna M. Unusual bacterial infections and colorectal carcinoma—Streptococcus bovis and Clostridium septicum: report of three cases. Dis Colon Rectum 2006;49(8):1223–1227. 7. Chew SS, Lubowski DZ. Clostridium septicum and malignancy. ANZ J Surg 2001;71(11):647–649. 8. Abella BS, Kuchinic P Hiraoka T, Howes DS. Atraumatic clostridial myone, crosis: case report and literature review. J Emerg Med 2003;24(4):401–405. 9. Furste W, Dolor MC, Rothstein LB, Vest GR. Carcinoma of the large intestine and nontraumatic, metastatic, clostridial myonecrosis. Dis Colon Rectum 1986;29(12):899–904. 10. Larson CM, Bubrick MP, Jacobs DM, West MA. Malignancy, mortality, and medicosurgical management of Clostridium septicum infection. Surgery 118(4):592–597. 11. Hill GB, Osterhout S. Experimental effects of hyperbaric oxygen on selected clostridial species. II. In-vitro studies in mice. J Infect Dis 1972;125(1):26–35. 1. Baylor University Medical Center Proceedings Volume 27, Number 2

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